Challenging dogmas : Intravenous versus oral beta-lactam antibiotic provocation tests
Molina-Molina, Gustavo-Jorge (Hospital Universitari de Bellvitge)
Gómez-Duque, Manuel (Hospital Universitari Vall d'Hebron)
Vidal Guitart, Xavier (Universitat Autònoma de Barcelona. Departament de Farmacologia, de Terapèutica i de Toxicologia)
Agustí Escasany, Antònia (Universitat Autònoma de Barcelona)
Labrador Horrillo, Moises (Universitat Autònoma de Barcelona)
Luengo Sánchez, Olga (Universitat Autònoma de Barcelona)
Sala-Cunill, Anna (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Galvan-Blasco, Paula (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Guilarte, Mar (Universitat Autònoma de Barcelona)
Cardona, Victoria (Hospital Universitari Vall d'Hebron. Institut de Recerca)

Date:	2024
Abstract:	Drug provocation tests (DPT) are considered the gold standard procedure to ascertain the diagnosis of beta-lactam (BL) allergy. Regarding route of administration, current recommendations prioritize oral challenges, considering them safer, and reserving the intravenous route for drugs for which this is the only formulation. To compare in terms of tolerance and safety two protocols of BL DPT, using an oral protocol (OR-DPT) and an intravenous protocol (IV-DPT). A descriptive, retrospective study was performed, including adult patients who underwent IV-DPT or OR-DPT for suspected immediate or delayed hypersensitivity to BL antibiotics, over a period of 4 years (between January 2018 and December 2021). Demographical data, index hypersensivity reactions' characteristics and tolerance to DPT were reviewed. A total of 1036 patients underwent DPT, mean age of 56. 8 (standard deviation, SD, 17. 8) years, 655 were women (63. 2%). Immediate drug hypersensitivity reactions (DHR) had occurred in 564 of patients (54. 4%). OR-DPT were performed in 439 (42. 4%) and IV-DPT in 597 (57. 6%). The frequency of reactions during DPT, regardless of the route used, was low (3. 6%): only 16 (3. 6%) in OR-DPT and 21 (3. 5%) in IV-DPT. From IV-DPT, 16 out 21 DHR during DPT were immediate compared with 4 out of 16 in OR-DPT. Adjusted relative risk of developing a hypersensitivity reaction during IV-DPT versus OR-DPT was 1. 13 (95% confidence interval (CI)0. 57-2. 22). The results suggest that OR-DPT and IV-DPT are both safe procedures when adequately performed. However, IV-DPT protocols showed a higher rate of immediate DHR during DPT probably due to the selection of basal high-risk patients to undergo IV-DPT. In conclusion, IV-DPT may be considered as an option for challenges in drug-allergy studies, entailing a precise administration.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Drug provocation test ; Beta-lactam ; Intravenous drug provocation test ; Oral drug provocation test ; Drug hypersensitivity reaction
Published in:	The World Allergy Organization Journal, Vol. 17 (may 2024) , ISSN 1939-4551

DOI: 10.1016/j.waojou.2024.100914
PMID: 38855082

14 p, 392.4 KB

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